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Vanassche T, Rosovsky RP, Moustafa F, Büller HR, Segers A, Patel I, Shi M, Miyoshi N, Mani V, Fayad Z, Stephan D, Schmidt J, Grosso MA, Tapson VF, Verhamme P, Huisman MV. Inhibition of thrombin-activatable fibrinolysis inhibitor via DS-1040 to accelerate clot lysis in patients with acute pulmonary embolism: a randomized phase 1b study. J Thromb Haemost 2023; 21:2929-2940. [PMID: 37178771 DOI: 10.1016/j.jtha.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The optimal treatment of intermediate-risk pulmonary embolism (PE) in hemodynamically stable patients remains unknown. Fibrinolytics reduce the risk of hemodynamic deterioration but increase bleeding risk. DS-1040, an inhibitor of thrombin-activatable fibrinolysis inhibitor, enhanced endogenous fibrinolytic activity without increasing bleeding risk in preclinical studies. OBJECTIVES To evaluate the tolerability and explore the efficacy of DS-1040 in patients with acute PE. METHODS In this multicenter, randomized, double-blind, placebo-controlled study, ascending doses of intravenous DS-1040 (20-80 mg) or placebo were added to enoxaparin (1 mg/kg twice daily) in patients with intermediate-risk PE. The primary endpoint was the number of patients with major or clinically relevant nonmajor bleeding. The percentage change in thrombus volume and right-to-left ventricular dimensions, assessed using quantitative computed tomography pulmonary angiography, at baseline and after 12 to 72 hours were used to explore the efficacy of DS-1040. RESULTS Of 125 patients with all available data, 38 were randomized to placebo and 87 to DS-1040. The primary endpoint occurred in 1 patient in the placebo group (2.6%) and 4 patients who received DS-1040 (4.6%). One subject experienced major bleeding (DS-1040 80 mg group); no fatal or intracranial bleeding occurred. Thrombus volume was 25% to 45% lower after infusion, with no differences between the DS-1040 and placebo groups. There was no difference in the change from baseline right-to-left ventricular dimensions between the DS-1040 and placebo groups. CONCLUSION In patients with acute PE, adding DS-1040 to standard anticoagulation was not associated with an increase in bleeding but did not improve thrombus resolution or right ventricular dilation.
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Affiliation(s)
- Thomas Vanassche
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
| | - Rachel P Rosovsky
- Thrombosis Research, Division of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fares Moustafa
- Emergency Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Indu Patel
- Clinical Development, Daiichi Sankyo, Basking Ridge, New Jersey, USA
| | - Minggao Shi
- Biostatistics, Daiichi Sankyo, Basking Ridge, New Jersey, USA
| | | | - Venkatesh Mani
- Department of Radiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Zahi Fayad
- Department of Radiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Dominique Stephan
- Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, Strasbourg, France
| | - Jeannot Schmidt
- Emergency Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michael A Grosso
- Clinical Development, Daiichi Sankyo, Basking Ridge, New Jersey, USA
| | - Victor F Tapson
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Peter Verhamme
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Menno V Huisman
- Department of Medicine-thrombosis and hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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